TITLE:
Exploring the Link between Constipation and Cardiovascular Risk: Evidence and Mechanisms
AUTHORS:
Muhammad Hassan, Damilola Oladinni, Gurkaranjot Singh, Renee Salem, Asha Gopu, Karm Ghei, Ochuwa Precious Imokhai, Angelique Putris, Julie Centofanti, Hayden Flume
KEYWORDS:
Constipation, Cardiovascular Disease, Myocardial Infarction, Stroke, Atrial Fibrillation, Heart Failure, Peripheral Heart Disease, Bowel Dysfunction, Major Adverse Cardiac Events, Mace, Gut Microbiota, Intra-Abdominal Pressure, Electrolyte Imbalance, Short Chain Fatty Acids
JOURNAL NAME:
Open Journal of Gastroenterology,
Vol.15 No.9,
September
19,
2025
ABSTRACT: Background & Objectives: Constipation, characterized by infrequent bowel movements and related symptoms, is increasingly recognized as a potential predictor for cardiovascular diseases (CVD), including myocardial infarction, atrial fibrillation, peripheral artery disease, stroke, heart failure, and major adverse cardiac events (MACE). This literature review aims to evaluate the current evidence linking constipation with cardiovascular outcomes, understand potential underlying mechanisms, and identify gaps requiring further research. Methodology: A comprehensive review was conducted, analyzing observational cohort studies, population-based studies, Mendelian randomization studies, systematic reviews, and meta-analyses. These studies were evaluated for their findings, methodological strengths, limitations, and adjustments for confounding factors. Results: Several studies revealed significant associations between constipation and cardiovascular outcomes. A Danish cohort study (n = 83,239) demonstrated increased risks for myocardial infarction (1.24-fold), atrial fibrillation (aHR 1.27), peripheral artery disease (aHR 1.34), and heart failure (aHR 1.52) in patients with constipation. A systematic review and meta-analysis reported a 41% increased stroke risk, particularly ischemic stroke (50% higher). Additionally, analysis of the UK Biobank data indicated a significant association between constipation and increased risk of MACE. Proposed mechanisms include gut dysbiosis, systemic inflammation, vagal nerve stimulation, increased intra-abdominal pressure, and medication-related electrolyte disturbances. Conclusion: Constipation is associated with increased cardiovascular risk, implicating potential mechanisms such as gut microbiota alterations, inflammation, and physiological stress during bowel movements. Despite robust observational associations, establishing causality remains essential, necessitating future Mendelian randomization and clinical intervention studies. Enhanced understanding and targeted management strategies may significantly impact cardiovascular outcomes, particularly in high-risk populations such as elderly individuals, diabetics, and patients with existing heart failure.